CMS/EIP Fiscal Report Center: 06
Services beginning 07/01/2024 ending 09/30/2024 Date of Report:04/06/2025 Page: 1
List order: No List
Agency Filter:EXT
Payclass Filters:MED
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 537 4070.250000 203980.1000 50.1149
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 131 620.000000 30995.5000 49.9927
OCCT-97530-OT SESSION BY LICENSED OT 2 7.000000 503.7200 71.9600
OCCT-97530GOGT-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 1 4.000000 287.8400 71.9600
OCCT-97530HMGT-OT SESSION BY OT ASST 1 3.500000 201.6000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 6 65.000000 4545.6400 69.9329
PHY-97110HM-PT SESSION BY PT ASST 8 48.250000 2770.4400 57.4184
PHY-97110HMGT-PT SESSION BY PT ASST 4 25.000000 1439.0000 57.5600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 7 28.000000 1970.9600 70.3914
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 6 24.750000 1781.0100 71.9600
Subtotal (Total Children Is Unduplicated) 633 4896.750000 248547.7700 50.7577
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Total 4896.750000 248547.7700 50.7577
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Number of Children (Unduplicated) With at Least One Service 633
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Center 06
Flag Claims Units Chgs Paid
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R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4908 4896.750000 248547.7700 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4908 4896.750000 248547.7700 0.0000